IMPACTS: Improving Medical Performance during Acute Crises Through Simulation

了解和提高临床医生管理危重事件的能力很重要 为了病人的安全。一个由临床科学家、模拟教育工作者和认知专家组成的团队 科学家们提出了一项五点深入研究实时行动导向决策-- 麻醉医生在一般性高保真危急事件中的策略制定 模拟。具体目标是：1)开发和测试统一的认知模型 和临床医生在危重事件中使用的决策策略的分类 管理；2)创建参与者的临床实践和模拟的详细档案 经验；3)评估影响医生危急事件表现的因素；以及 4)评估基于模拟的绩效评估与 医生能力的现有指标(参与者的初级董事会证书 考试成绩)。我们将创建四个20分钟的关键事件真实模拟 与许多急救专科相关。120名不同职业的麻醉师 Points将提供详细的人口统计、临床实践和模拟体验 数据。在所有四种情况下，他们都将佩戴头盔摄像机进行表演。 每个参与者的活动管理的成功程度将在稍后从管理费用中进行评估 基于及时完成预定义的独立培训专家的视频 “关键业绩要素”和全球技术和非技术分数。在每个 情景，将使用视频线索回忆进行认知访谈，以确定 他们如何以及为什么做出临床管理决策。我们将迭代地编写代码 并分析所有采访数据，以制定决策策略的分类；每个 将针对所使用的策略对场景进行编码。然后我们将分析事件如何 表现评级因以下因素而异：参与者的实际练习和模拟经验， 所使用的决策策略，以及笔试和口试 得分。这项创新的研究将深入描绘一个不同的 管理危急事件的医生样本。与这些经验数据一起， 该项目将为动态临床决策创建新的模型和分类， 扩展以前为医疗保健和其他类似领域开发的模型 认知需求(例如航空)。这项研究将产生关于以下方面的最佳实践指南 关键事件管理中的决策和支持决策的信息 关于基于模拟的培训和评估的内容、实施和时机。

Understanding and improving clinicians' ability to manage critical events is important for patient safety. A team of clinician-scientists, simulation educators, and cognitive scientists propose a five-site in-depth study of the real-time action-oriented decision- making strategies of anesthesiologists during generalizable high-fidelity critical event simulations. The Specific Aims are to: 1) Develop and test a unified cognitive model and taxonomy of the decision-making strategies clinicians use during critical event management; 2) Create detailed profiles of participants' clinical practice and simulation experience; 3) Evaluate the factors affecting physicians' critical event performance; and 4) Evaluate the relationship between simulation-based performance assessment and existing metrics of physician competence (participants' primary board certification exam scores). We will create four 20-minute realistic simulations of critical events that are relevant to many acute-care specialties. 120 anesthesiologists at varying career points will provide detailed demographic, clinical practice, and simulation experience data. They will wear head-mounted video cameras as they perform in all four scenarios. Success of each participant's event management will be assessed later from overhead videos by independent trained experts based on timely completion of pre-defined `critical performance elements' and global technical and non-technical scores. After each scenario, cognitive interviews will be conducted using video-cued recall to ascertain how and why they made their clinical management decisions. We will iteratively code and analyze all of the interview data to develop a taxonomy of decision strategies; Every scenario will be coded for the strategies used. We will then analyze how event performance ratings vary with: participants' actual practice and simulation experience, the decision strategies used, and written and oral board certification examination scores. This innovative study will delineate in depth the thought processes of a diverse sample of physicians in managing critical events. Along with these empirical data, the project will create a new model and taxonomy for dynamic clinical decision-making, extending models previously developed for healthcare and other arenas of similar cognitive demands (e.g. aviation). The study will yield best-practice guidelines on decision-making in critical event management and information to support policymaking about the content, execution, and timing of simulation-based training and assessment.